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HomeMy WebLinkAbout2020-928-E Aging - Meals on Wheels outside agency agreement DocuSign Envelope ID:51A7Al37-A286-4E98-B5F2-Al7F8C86549D OUTSIDE AGENCY PERFORMANCE AGREEMENT THIS AGREEMENT,made and entered into the first day of July 2020, ("Effective Date")by and between the County of Orange, a political subdivision of the State of North Carolina,200 South Cameron Street, Hillsborough,North Carolina, 27278, ("County") and Meals on Wheels of Orange County, a not-for-profit corporation, located at 632 Laurel Hill Road, Chapel Hill, NC 27514 ("Provider"). WITNESSETH: WHEREAS, it is in the interests of the County that said program be assisted by the County and thereby enhance its availability to residents of the County, and said program addresses an important community human services need, as identified by the Board of Commissioners. NOW, THEREFORE, in consideration of the above and the mutual covenants and conditions hereafter set forth,the County and Meals on Wheels of Orange County agree as follows: 1. Term of the Agreement. The term of this Agreement shall be a program year beginning July 1, 2020 to June 30,2021. 2. Scope of Services. a. Provider will provide services, as outlined in the attached Outside Agency Funding Application and any amendments or revision thereto which is attached as Exhibit "A" and incorporated by reference, to the residents of Orange County. The Scope of Services and the Program Budget may be different from the original application based on County appropriation; however, any revisions or amendments to this Agreement must be approved in writing by the County and attached to this Agreement as Exhibit B. b. The Provider shall be solely responsible for the means,methods,techniques,sequence,safety program and procedures necessary to properly and fully complete the work set forth in the Scope of Services. 3. Funding. a. The County agrees to appropriate for the provision of services described in Exhibit A, Scope of Services and more particularly described in the Revised Program Budget, the maximum sum of$44823. b. All funds appropriated shall be used for purposes described in Exhibit A. Any funds not used for the purposes stated shall be returned to the County. Any changes in the use of funds must be authorized in writing by the County prior to any expenditure of the funds by the Provider. If the funds are expended not in accordance with the Scope of Services, at the discretion of the County the Provider may be required to repay the funds to the County. c. The Provider shall be paid in four equal installments in the amount of$ 11205.75. The first payment is contingent upon receipt of the agency's performance agreement; the remaining payments are contingent upon receipt of the request for reimbursement and related supporting documentation. (aAgencys_Name») Orange County Outside Agency Performance Agreement Revised 712018 Page 1 of 9 DocuSign Envelope ID:51A7Al37-A286-4E98-B5F2-Al7F8C86549D d. The County's obligation to make the quarterly payments is contingent upon receipt of Progress Reports, which show satisfactory progress toward completion of performance measures and an accounting of expenditures as detailed in the attached Scope of Services. e. Once Provider has satisfied its obligations as provided in(d) payment will be made 21 days after receipt of the Progress Report and Request for Reimbursement or 21 days after due date of Progress Report whichever is later. f. The County is not obligated to provide any other support to Provider in this or in succeeding fiscal years. 4. Agency Reporting. a. Provider will provide Orange County a Progress Report that includes a fiscal report and updates on performance measures as outlined in the Scope of Services. Progress Report dates are: July 1 —December 31; January 1 —March 31 and April 1 -June 30. Reports are due on January 11,April 12,and July 12 of the program fiscal year. b. Provider agrees to allow the County to inspect its financial books and records, which document costs of those services,upon reasonable notice during normal working hours. 5. Termination. a. In the event of any of the circumstances set forth below(hereinafter referred to as"default"), the County may immediately terminate this Agreement,in whole or in part,and from time to time.Notice of termination must be in writing,state the reason or reasons for the termination, and specify the effective date of the termination: i. In the event that Provider shall cease to exist as an organization or shall enter bankruptcy proceedings,be declared insolvent,or liquidate all or substantially all of its assets, or significantly reduce its services or accessibility to Orange County residents during the term of this Agreement; or ii. In the event that Provider shall fail to render a satisfactory accounting as provided section 4 above,the County may terminate this Agreement and Provider shall return all payments already made to it by the County for services which have not been provided or for which no satisfactory accounting has been rendered; or iii. In the event of any fraudulent representation by the Provider in an invoice or other verification required to obtain payment under this Agreement or other dishonesty on a material matter relating to the performance of services under this Agreement. iv. Nonperformance,incomplete service or performance, or failure to satisfactorily perform any part of the work identified in the Scope of Services or to comply with any provision of this Agreement, as determined by the County in its sole discretion. v. Failure to adhere to the terms of applicable county, state or federal laws, regulations, or stated public policy. b. In the event of default by the Provider,the county may elect to terminate this Agreement, in whole or in part and/or require the Provider to repay the funds within ten(10)business days from written notice of default. The County may (but shall not be required to) grant the (aAgencys_Name») Orange County Outside Agency Performance Agreement Page 2 of 9 Rev. 7118 DocuSign Envelope ID:51A7Al37-A286-4E98-B5F2-Al7F8C86549D Provider an opportunity to cure the default without termination of this Agreement. This clause shall not be interpreted to limit the County's remedies in law or in equity. c. Notwithstanding the foregoing,either party may terminate the agreement at any time without penalty; provided that written notice of such termination is furnished to the other party at least 30 days prior to termination. In the event of such termination, any payment due shall be prorated to the date of termination and any unused funds shall be returned to the County within 10 days of termination. d. Any termination of this Agreement for default under this section that is later deemed to be unjustified shall be deemed a termination for convenience. 6. Insurance. a. General Requirements. The Provider shall purchase and maintain,during the period of performance of this Agreement, insurance: i. Worker's Compensation. For protection from claims under workers'or workmen's compensation acts; ii. Comprehensive General Liability Insurance covering claims arising out of or relating to bodily injury, including bodily injury, sickness, disease or death of any of the Consultant's employees or any other person and to real and personal property including loss of use resulting thereof; iii. Comprehensive Automobile Liability Insurance,including hired and non-owned vehicles, if any, covering personal injury or death, and property damage; and iv. Professional Liability Insurance,covering personal injury,bodily injury and property damage and claims arising out of or related to the performance under this Agreement by the Consultant or his agents, consultants and employees. b. Limits of Coverage: Minimum limits of insurance coverage shall be as follows: INSURANCE DESCRIPTION MINIMUM REQUIRED COVERAGE • Worker's Compensation Limits for Coverage A-Statutory State NC&Coverage B -Employers Liability $500,000 each accident, disease policy limit and disease each employee • Commercial General $1,000,000 Each Occurrence Liability $2,000,000 Aggregate • Automobile Liability $500,000 Combined Single Limit • Professional Liability $1,000,000 Each Occurrence $2,000,000 Aggregate c. All insurance policies(with the exception of Worker's Compensation and Professional Liability)required under this Agreement shall name the County as an additional insured party and as a certificate holder. Evidence of such insurance and all correspondence shall be sent to: Orange County Risk Manager Post Office Box 8181 Hillsborough,NC 27278 (aAgencys_Name») Orange County Outside Agency Performance Agreement Page 3 of 9 Rev. 7118 DocuSign Envelope ID:51A7Al37-A286-4E98-B5F2-Al7F8C86549D d. Nothing in this section is intended to affect or abrogate the County's sovereign immunity defenses. 7. Relationship of the Parties. Provider is an independent contractor of the County. Provider represents that they have or will secure, at his own expense, all personnel required in performing the services under this Agreement. Such personnel shall not be employees or have any contractual relationship with the County. All personnel engaged in work under this Agreement shall be fully qualified and shall be authorized and permitted under federal, state and local law to perform such services. 8. Compliance with all Laws. The Provider, at its sole expense, shall comply with all laws, ordinances, orders and regulations of the federal, state or local governments, as well as their respective departments, commissions, boards, and officers, which are in effect at the time of execution of this Agreement or are adopted at any time following execution of this agreement. 9. Subcontract. The County and Provider deem the services provided under this Agreement to be personal in nature and Provider may not subcontract any rights or duties under this Agreement to any other party without prior written consent from the County. 10. Assignment. The Provider shall not assign this Agreement,including the rights to payment,to any other party without the prior written consent of the County. 11. Indemnification. Provider agrees to defend,indemnify,and hold harmless the County,for all loss, liability, claims or expense (including reasonable attorney's fees) arising from bodily injury, including death or property damage, to any person or persons caused in whole or in part by the negligence or willful misconduct of the Provider, except to the extent same are caused by the negligence or willful misconduct of the County. It is the intent of this section to require Provider to indemnify the County to the extent permitted under North Carolina law. Nothing in this section is intended to affect or abrogate the County's sovereign immunity defenses. 12. Non-Appropriation. This Agreement is subject to the availability of funds to purchase the specified services and may be terminated at any time if such funds become unavailable. 13. Non-Discrimination. Provider agrees as part of consideration of the granting of funds by Orange County the parties hereto for themselves,their agents, officials, employees and servants agree not to discriminate in any manner of these basis of race, color, gender,national origin, age, handicap, religion,sexual orientation,familial status or veterans status with reference to any activities carried out by the grantee,no matter how remote. The parties hereto further agree in all respects to conform to the provision and intent of Orange County Civil Rights Ordinance, as amended and the Orange County Non-discrimination Policy. This provision is enforced by action for specific performance, injunctive relief, or other remedy as by law provided; this provision shall be binding on the grantees, the successors and assigns of the parties hereto with reference to the above subject manner. 14. Living Wage. Orange County is committed to providing its employees with a living wage and encourages agencies if funds to pursue the same goal. The County's living wage is $ 14.95 per hour. To the extent possible, Orange County recommends Charles House Association provide a living wage to its employees. 15. Notice. The Parties hereto agree and understand that written notice,mailed or delivered,to the last known address shall constitute sufficient notice to the County and the Provider. All notices (aAgencys_Name») Orange County Outside Agency Performance Agreement Page 4 of 9 Rev. 7118 DocuSign Envelope ID:51A7Al37-A286-4E98-B5F2-Al7F8C86549D required and/or made pursuant to this Agreement to be given to the County and the Provides shall be in writing and mailed to the party addressed as follows: County: Finance&Administrative Services Provider: Rachel Sobel Bearman Orange County 632 Laurel Hill Road, Post Office Box 8181 Chapel Hill,NC 27514 Hillsborough,NC 27278 16. Entire Agreement. This Agreement, including any referenced attachments, constitutes the entire Agreement between the parties and shall supersede,replace or nullify any and all prior Agreements of understandings; written or oral, relating to the matters set forth herein, and any such prior Agreements or understandings shall have no force or affect whatsoever on this Agreement. The County and Provider have read this Agreement and agree to be bound by all of its terms,and further agree that this Agreement constitutes the complete and exclusive statement of the Agreement between the County and Provider. 17. Severability. All clauses found herein shall act independently of each other. If a clause is found to be illegal or unenforceable, it shall have no effect on the other provisions of this Agreement. It is understood by the parties hereto that if any part, term or provision of this Agreement is by the Courts held to be illegal or in conflict with any laws of the State of North Carolina or the United States,the validity of the remaining portions or provisions shall not be affected, and the rights and obligations of the parties shall be construed and enforced as if the Agreement did not contain the particular part,term or provision held to be invalid. a. Governing Law. This Agreement and the duties, responsibilities, obligations and rights of respective parties hereunder shall be governed by the laws of the State of North Carolina. By executing this Agreement Provider affirms that Provider and any subcontractors of Provider are and shall remain in compliance with Article 2 of Chapter 64 of the North Carolina General Statutes. By executing this Agreement Provider certifies that Provider has not been identified,and has not utilized the services of any agent or subcontractor,on the list created by the State Treasurer pursuant to G.S. 147-86.58. 18. Signatures. This Agreement together with any amendments or modifications may be executed electronically. All electronic signatures affixed hereto evidence the intent of the Parties to comply with Article I IA and Article 40 of North Carolina General Statute Chapter 66. IN WITNESS WHEREOF,the Orange County and the Provider have signed this Agreement, effective on the last date this Agreement is signed by both parties as indicated by the dates set forth under signatures below. Fr, ��; , half of the Provider ,�, �,gyktq,�, 11/2 8/2020 Mea s on Whee s of Orange County Date (aAgencys_Name») Orange County Outside Agency Performance Agreement Page 5 of 9 Rev. 7118 DocuSign Envelope ID:51A7Al37-A286-4E98-B5F2-Al7F8C86549D DA ,Wbpehalf of Orange County Government bb[&Adt, 12/2/2020 Bonnie ammersley, County Manager Date (aAgencys_Name») Orange County Outside Agency Performance Agreement Page 6 of 9 Rev. 7118 DocuSign Envelope ID:51A7Al37-A286-4E98-B5F2-Al7F8C86549D ORANGE COUNTY—DEPARTMENT USE ONLY Department Party/Vendor Name: Meals on Wheels of Orange County Party/Vendor Contact Person: Rachel Sobel Bearman Contact Phone: 919-942-2948 Party/Vendor Address: 632 Laurel Hill Road City Chapel Hill State:NC Zip: 27514 Department: Finance&Administrative Services Amount:$44823 Purpose: FY 2020-21 Outside Agency/Human Services Performance Agreeement Budget Code(s): 10495050-719053 Vendor#80080 Vendor is a BOCC consultant? Yes ❑No❑ Contract Type: (Check one)New Renewal x❑ Amendment ❑ Effective Date 7/l/2020 Approved by Board Yes®Nor-1 Agenda Date: This agreement is approved as to to M "lind content: alniGt � b_ / / Department Director's Signature �e�ess�as Date: 11 28 2020 Information Technologies (Applicable only to hardware/software purchases or related services)This agreement has been reviewed and is approved as to information technology content and specifications: Office of the Chief Information Officer Date: Risk Management This agreement is approved for sufficienc ea xi*:standards,specifications,and requirements: QLtSA rbVlnt,{fb 11/30/2020 Office of the Risk Management Office Date: Financial Services This instrument has been pre-audited i elf ftquired by the Local Government Budget and Fiscal Control Act: lq� ,� Q. 12/1/2020 Office of the Chief Financial Officer Date: Legal Services This agreement is approved as to 2i4mm-arjd sufficiency: Office of the County Attorney "\ Date: 12/2/2020 Clerk to the Board Received for record retention: All Docusign contracts must be copied to Sherri Ingersoll upon completion @ singersoll&oran e�ync•gov The following signature block is for hard copies only and is not required for Docusign contracts: Office of the Clerk to the Board Date: (<Mgencys_Name») Orange County Outside Agency Performance Agreement Page 7 of 9 Rev. 7118 DocuSign Envelope ID:51A7Al37-A286-4E98-B5F2-Al7F8C86549D Exhibit A Provider's Outside Agency Application (aAgencys_Name») Orange County Outside Agency Performance Agreement Page 8 of 9 Rev. 7118 DocuSign Envelope ID:51A7A137-A286-4E98-B5F2-A17F8C86549D Exhibit B Provider's Revised Scope of Services and Program Budget (aAgencys_Name») Orange County Outside Agency Performance Agreement Page 9 of 9 Rev. 7118 DocuSign Envelope ID:51A7Al37-A286-4E98-B5F2-Al7F8C86549D ATTACHMENT "A" Orange County Certifications—FY 2018-19 Outside Agency Performance Agreement Chief Contact,Administrators, Chief Executive Officer and Chief Financial Officer I certify that I have provided a list of the chief contact, administrators, chief executive officer and chief financial officer for my agency with this Agreement and that I will keep it current to the County of Orange. The list should be in writing with the name,title,residential address;phone and email address and if possible, fax number. Officers and Board of Directors I certify that I have provided a current list of the Officers and Board of Directors with this Agreement and that we will continue to update the list as changes occur. The list should be in writing,with the name, physical address,mailing address and if possible,phone, fax and email address. Budget Submission I certify that I have provided a budget for the period to be covered by funding Orange County, and that any substantive changes made to this budget have been in advance authorized in writing by Orange County. Annual Financial Review I certify that I have provided a copy of the latest annual Financial Review for our agency and the budget adopted by the agency for the fiscal years encompassing this Agreement. If not,please explain on a separate sheet of paper. Alignment with Organization's Mission I certify that the programs and services for which this funding is requested align with the mission of the organization. Intended Purpose I certify that the funds provided to the agency under the terms of this Agreement will be used for a public purpose and shall only be used for the purposes intended and any money not used for those purposes will be promptly returned to Orange County. DocuSigned by: Certified by: 1� � Title: Date: 11/28/2020 (Provider's Signature) (aAgencys—Name») Orange County Outside Agency Performance Agreement Page 10 of 9 Rev. 7118 DocuSign Envelope ID:51A7A137-A286-4E98-B5F2-A17F8C86549D COVER PAGE Applicant Contact Information Applicant Organization's Legal Name: Chapel Hill Carrboro Meals on Wheels (DBA Meals on Wheels of Orange County—MOWOCNC, by July 1 of 2020) Applicant Organization's Physical Address: 1712 Willow Drive,Chapel Hill, NC 27514 Applicant Organization's Mailing Address: P.O. Box 2102, Chapel Hill, NC 27515 Applicant Organization's Web Address: www.chcmow.org Executive Director: Rachel Sobel Bearman Telephone Number: 919-942-2948 E-Mail: rachel.bearman@chcmow.oM Tax ID Number: 59-1721954 Funding Request Please list all Fiscal Year 2021 Human Services(HS)funding requested for all programs and the proposed use of funds(please list program name only) Program Carrboro- Chapel Hill Orange Total HS -HS County-HS In-Home Meal Delivery and Weekday Daily Check-In $18,000 $45,000 $80,800 Operations Operations Operations &Personne Totals N 1000 or 45 00 Briefly explain your proposed use of funds: Funding directly supports the delivery of a hot, balanced meal along with a friendly check-in, Monday-Friday,to older adults, homebound adults, adults with disabilities and those convalescing, who do not have access to, or the ability to prepare a healthy meal. To the best of my knowledge and belief all information and data in this application is true and current. The document has been duly authorized by the governing board of the applicant. Signatur • t 1 1Q (F01-0 "T Executive—etector Date Signature: �'_�;� � Z,� Board Chairperson Date Cover Page DocuSign Envelope ID:51A7A137-A286-4E98-B5F2-A17F8C86549D DISCLOSURE OF POTENTIAL CONFLICTS OF INTEREST AND NON DISCRIMINATION CLAUSE Are any of the Board Members or employees of the agency which will be carrying out this program or members of their immediate families, or their business associates. YES NO X❑ ❑ a]Employees of or closely related to employees of the Town of Carrboro,the Town of Chapel Hill, or Orange County? ❑ X❑ b) Members of or closely related to members of the governing bodies of the Town of Carrboro,the Town of Chapel Hill, or Orange County? ❑ X❑ c) Current beneficiaries of the program for which funds are being requested? ❑ X❑ d) Paid providers of goods or services to the program or having other financial interest in the program? If you have answered YES to any question, please provide a full explanation below. The current Operations Coordinator for OCRA is married to an Orange County Sheriff's Deputy. When the organizations merger she is planning to maintain her Operations Coordinator position. NON-DISCRIMINATION Provider agrees as part of consideration of the granting of funds by funding agencies to the parties hereto for themselves, their agents, officials, employees and servants agree not to discriminate in any manner of these basis of race, color,gender, national origin, age, handicap, religion,sexual orientation, gender identity/expression,familial status or veterans status with reference to any activities carried out by the grantee, no matter how remote. The parties hereto further agree in all respects to conform to the provision and intent of Orange County Civil Rights Ordinance, as amended and the Orange County Anti-discrimination Policy. This provision is enforced by action for specific performance, injunctive relief,or other remedy as by law provided;this provision shall be binding on the grantees,the successors and assigns of the parties hereto with reference to the above subject manner. To the best of my knowledge and belief all of the above information is true and current. I acknowledge and understand that the existence of a potential conflict of interest does not necessarily make the program ineligible for funding,but the existence of an undisclosed conflict may result in the termination of any grant awarded. Signatu I [0 202-0 �Execirector Date Signature: Board hairperson Da Cover Page Page 7 of 23 DocuSign Envelope ID:51A7Al37-A286-4E98-B5F2-Al7F8C86549D AGENCY INFORMATION Please provide the following information about your agency: 1. Date of Incorporation (Month/Year): 08/1976 2. Agency's Purpose/Mission (no more than a few sentences): CHCMOW: We nourish the bodies and spirits of the homebound with a balanced meal and the human connection they need to help them live independently. OCRA: In alliance with community partners, OCRA advocates for rural seniors supporting them to live independent and dignified lives—access to county services, safe homes, nutritious food, and friendly human contact. OCRA's main mission towards this goal is to provide weekly hot, nutritious meals to rural seniors in underserved areas of rural Orange County. (MOWOCNC) Meals on Wheels Orange County, Serving Chapel Hill, Carrboro and Rural Orange County: To enhance the well-being of older adults, homebound adults, adults with disabilities and those convalescing, by alleviating hunger and reducing isolation. 3. Please provide a brief description of your organization's past achievements in carrying out similar projects and evidence of successful record of meeting proposed budgets and timetables (no more than 100 words) Strong fiscal management and mission focus has enabled CHCMOW to meet the challenges of increasing numbers of recipients in need with decreasing capacity to pay. We consistently grow each year either in number of meals delivered, number of people served, or both. We are able to leverage community support and volunteer power to serve a higher number of recipients than our income alone would accommodate. Increased need and limited financial resources required CHCMOW to start a waitlist in January. As we strive to provide equal access to our service across the county, the waitlist will be dependent on funding. 4. Living Wage: Does this agency pay permanent employees a minimum living wage?(Yes/No) Yes If yes, is this agency an Orange County Living Wage Certified Employer?Yes If no, please briefly explain. Schedule of Positions: #of FTE—Full-Time Paid Positions: 1 #of FTE—Part-Time Paid Positions: 4 Program information Pa g e 8 of 2 3 DocuSign Envelope ID:51A7Al37-A286-4E98-B5F2-Al7F8C86549D PROGRAM INFORMATION *Please submit for each program if applying for funding for more than one program. 5. Program Name: In-Home Meal Delivery and Weekday Daily Check-in Program Primary Contact and Title: Rachel Bearman, Executive Director Telephone Number: 919-942-2948 E-Mail: rachel.bearman@chcmow.org 6. Please briefly describe the proposed program, including an explanation of how it aligns with the Town of Chapel Hill and Carrboro's Results Framework, and Orange County BOCC Goals and Priorities, and the target population to benefit from the program. (100 words or less) MOWOCNC delivers a hot, nutritious meal along with a weekday daily check-in to older adults, homebound adults and adults with disabilities who do not have access to or the ability to prepare a healthy meal. MOWOCNC supports recipients' ability to age in place with dignity, providing sustenance and human connection while improving health, alleviating hunger and reducing isolation. MOWOCNC improves the livelihoods security as well as health outcomes of our recipients and we play a vital role in ensuring a community network of basic human services and infrastructure that maintains, protects, and promotes the well- being of all county residents. 7.Target Population: Please complete the table below with numbers (not percentages) of individuals served and projected to be served. Chart lists both CHCMOW and OCRA (in parentheses) in 2018-19 and 2019-20. 2020-21 is the merged organization. The numbers do not align perfectly between the organizations because CHCMOW #'s follow the fiscal year of the grant, OCRA's numbers follow a calendar year. Program Target Population Demographics Projected Actual projected Projected 2018-19 2018-19 2019-20 2020-21 (2018 (2019 (2020 OCRA) OCRA) OCRA) Gender Men 95 (41) 94(35) 110(37) 171 Women 195 (109) 200(85) 210(88) 239 Nonbinary/Genderqueer n/a Self-Describe n/a 294 410 Total 290(150) (120) 320(125) Race and Ethnicity Black or African-American 122 (51) 124(49) 131 (52) 167 American Indian or Alaska Native 2 2 Asian 5 6 5 8 Program information Pa g e 9 of 2 3 DocuSign Envelope ID:51A7A137-A286-4E98-B5F2-A17F8C86549D White 156(95) 158(71) 170(73) 225 Native Hawaiian or other Pacific Islander Two or more races Some other race 7(4) 4(0) 14(0) 8 294 410 Total 290(150) (120) 320(125) Of the above, how many Hispanic/Latino 7(4) 4(0) 14(1) 10 290 400 Of the above, how many non-Hispanic/Latino 283 (146) (120) 306(124) 294 410 Total 290(150) (120) 320(125) Age 0-5 years 6-18 years 19-50 years 9(2) 12 10 12 282 398 51+years 281(148) (120) 310(125) 294 410 Total 290(150) (120) 320(125) Geographic Location Town of Chapel Hill 148 159 157 168 Town of Carrboro 81 81 91 97 Orange County(Outside of Chapel Hill/Carrboro) 61(150) 54(120) 72(125) 145 Outside of Orange County 294 410 Total 290(150) (120) 320(125) Income Low-income(80%of the Area Median Income and Below) Please see 264-294* 320(125) 400 income table in the attachments 290(150) (120) 264-294* 410 Total 1 290(150) 1 (120) 1 320(125) *all CHCMOW meals are subsidized. We have 30 who pay our highest rate but a number of those are paid by relatives. We ask basic questions about monthly income to determine scale. I would guesstimate that of that 30 who pay the highest fee about 10 are above the low-income. OCRA: The target population reflects all clients enrolled in the program to date through the end of calendar 2019. Due to attrition, the number of clients that OCRA serves each week (recurring clients) is lower. 37 clients left us, 11 died, 5 to assisted care, 6 transferred to OCIM and 11 got better. OCRA had 120 recurring clients 2019, and estimates 147 recurring clients in year 2020, and estimates 160 recurring clients for 2021. **OCRA does not inquire about income, but we estimate that 95% of our seniors fall below the 80% of Area Medium Income ($47,500) Program information Pa g e 10 of 2 3 DocuSign Envelope ID:51A7A137-A286-4E98-B5F2-A17F8C86549D 8. Cost Per Individual This cost per individual must reflect the total program budget divided by the total number of program individuals in this application. Projected 2020-21 Actual 2018-19 Projected 2019-20 Meals on Wheels CHCMOW CHCMOW Orange County MOWOCNC) Total Cost of Program $366,906 $405,000 $544,177 Total #of Individuals 294 320 410 Cost Per IndividualNear -$1,248 -$1,266 -$1,327 OCRA Cost per Individual(eased on calendar year not grant fiscal year). Actual 2018 Actual 2019 Projected 2020 OCRA OCRA OCRA Total Cost of Program' $31,535 $53,667 $58,745 Total #of IndividualsZ 93 88 avg/wk 92 avg/wk Cost Per 3 $5.11 $9.15 $10.01 Individual/meal 'Program costs for 2019-2020 reflect two meals per week. 'The total number of individuals is based on the year end number of clients served weekly. 3The cost per individual varies due to client changes and donated meals. The average total meal costs are $53,667, donated meals are worth $32474 and donated desserts are $7040 making the total meals cost $62,938. 9. Performance Indicators For Chapel Hill and Carrboro applicants: Please complete the following chart with information about the Strategic Objective, Intermediate Result, and the Agency Performance Indicator for each program for which you are applying for funding. Please see the Results Framework in the Attachments section as a reference. Program Name: Strategic ❑ Children improve their educational outcomes Objective (please choose one from X Residents Increase their livelihood security the Results Framework) X Residents improve their health outcomes Intermediate Insert Intermediate Result here. Result (please choose one from the Results Framework) A. Residents access the most appropriate social safety net services B. Residents demonstrate new healthy lifestyle behaviors RESULTS Actual Projected Projected Program information P a g e 1 1 o f 2 3 DocuSign Envelope ID:51A7A137-A286-4E98-B5F2-A17F8C86549D 2018-19 2019-20 2020-21 Performance Insert Performance Indicator here. 294 320 Indicators 410 (Please choose at least A # Of participants that one performance receive food indicator to report on assistance from the Results Framework,and add additional performance indicators that you would like to report to the Towns. Please insert additional rows as needed,listing one per row). B. # of program (new stat for 200;63% 258; 63% participants who 2019 data report new, collectionno comparative improved or restored data yet just social connections anecdotal evidence. Estimate that over50%of recipients are less lonel /isolated B. # of program 294 320 410 participants that consume fresh food Program information Pa g e 12 of 2 3 DocuSign Envelope ID:51A7A137-A286-4E98-B5F2-A17F8C86549D ORANGE COUP N4IK I I I r 'r5J'47L Ur": , Outside Agencies/Human Services Please use the drop down menu below to select which function area best aligns with your agency and program(s) in which you are requesting funding. Please select only one from the drop down menu below. Food and Nutritional Services If you selected other, please tell us what function area best aligns with your organization: Please indicate three program goals/performance measures below. Ensure a community network of basic human services and infrastructure that maintains, protects, and promotes the well-being of all county residents Program Goal# 1 Increase equal access to meals on wheels service across Orange County Performance Measure Increase number of seniors who have access to meal (How will you accomplish your goal?) delivery and check-in up to 5 times per week. Actual Results N/A (Outcome) Ending FY18-19 Projected Results 400 Individuals (Outcome) Ending FY2020 Projected Results Increase in # of meals to rural recipients from 1-2 to at (Outcome) least 3, if not more, as funding permits. Ending FY2021 Reduce Isolation/loneliness amongst older adults, Program Goal# 2 homebound adults, disabled adults and those convalescing, measured via survey. Percent of recipients reporting reduced feelings of social Performance Measure isolation and loneliness. (How will you accomplish your goal?) Actual Results New Data not yet 6collected. (Outcome) Ending FY18-19 Projected Results 50% of recipients. Program information Pa g e 13 of 2 3 DocuSign Envelope ID:51A7A137-A286-4E98-B5F2-A17F8C86549D ONE COUNTY N4IK I I I rr5J'47L' S�..� U[": t Outside Agencies/Human Services (Outcome) Ending FY2020 Projected Results 50% of recipients. (Outcome) Ending FY2021 Program Goal#3 Community Outreach: Increase# of Volunteers to increase meal delivery service Performance Measure # of New Volunteers (How will you accomplish your goal?) Actual Results 350 volunteers in 2018-19 (Outcome) Ending FY18-19 Projected Results Approximately 20 additional volunteers (Outcome) Ending FY2020 Projected Results Approximately 20 additional volunteers (Outcome) Ending FY2021 Program information Pa g e 14 of 2 3 DocuSign Envelope ID:51A7Al37-A286-4E98-B5F2-Al7F8C86549D Agency Budget: Meals on Wheels of Orange County, Serving Chapel Hill, Carrboro and F Operating Budget for Program PROGRAM NAME: In-Home Meal Delivery and Weekday Daily CI Actual Actual Estimated 2018-19 2018-2019 2019-20 PROGRAM REVENUE CHCMOW OCRA CHCMOW Private Donations $ 177,609 $ 27,849 $ 180,000 Program Generated Revenue "$ 51,32,0 $ 56,040 Local Government Grants: Human Services -Town of Carrboro $ 15,000 $ 13,500 Other-Town of Carrboro $ - $ - Human Services -Town of Chapel Hill $ 17,500 $ 21,000 Other-Town of Chapel Hill $ - $ - Human Services -Orange County $ 23,167 $ 20,750 $ 17,355 Other-Orange County $ - $ 1,817 $ - Other-Town of Hillsborough $ - $ - Other Government Grants Triangle United Way $ 4,009.00 $ 3,500.00 State Government $ - $ - Federal Government (CDBG/HOME/etc.) $ - $ - Private Foundation Grants $ 21,802.00 $ 40,000.00 Other Revenue $ 66,218 $ 1,772 $ 70,000 Total Program Revenue $ 376,625 $ 52,188 $ 401,395 PROGRAM EXPENSES Compensation $ 88,391 $ 13,915 $ 126,296 Rent& Utilities $ 2,081 $ 3,859 $ 2,500 Supplies & Equipment $ 212,478 $ 19,434 $ 243,052 Travel &Training $ 3,770 $ 2,500 Other Expenses: $ 57,000 $ 8,781 $ 83,040 Total Program Expenses $ 363,720 $ 45,989 $ 457,388 SURPLUS/(DEFICIT) FOR PERIOD: $ 12,905 $ 6,199 $ (55,993) Please explain Other Grants CHCMOW has received a two year Triangle Community Foundation Capacity Building Grant as well as grant fL Community. Other grants are in the process of being applied for. Does your program budget show a surplus or deficit? Please provide a brief explanation for the surplus DocuSign Envelope ID:51A7A137-A286-4E98-B5F2-A17F8C86549D In 2018-19 CHCMOW had a surplus based on a particularly successful fundraising event as well as n-kind dor expenses. In 2019-20 we project a loss based on an increase in number of recipients served in late 2019 bey those additional costs (hence the start of a waitlist in January 2020)as well as expenses related to the merge accounting for increases in food cost, increased staff hours, and volunteer outreach. MOWOCNC: 2020-21 we project a deficit that appears smaller than expected due to increased asks of Chape OCRA: We are very aggressive and efficient at securing donated meals from local businesses and other chari- Therefore our actual costs per meal per individual is much lower. BOCC authorized in 2019/2020 a grant for 9 disbursement to date, 1/8/2020. DocuSign Envelope ID:51A7A137-A286-4E98-B5F2-A17F8C86549D tural Orange ieck-in Estimated Projected 2019-20 2020-21 Percent OCRA MOWOCNC Change $ 35,080 $ 200,000 11% $ 60,000 ii7% $ 18,000 33% $ - 0 $ 45,000 114% $ - 0 $ 27,488 $ 80,800 366% $ - 0 $ - 0 "M $ 1,000.00 $ 0.71 $ - 0 $ - 0 $ 3,000.00 $ 45,000.00 $ 0.13 $ 2,056 $ 74,000 $ 0.06 $ 67,624 $ 523,800 30% $ 17,277 $ 165,594 31% $ 4,980 $ 4,600 84% $ 24,776 $ 285,000 17% $ 3,000 20% $ 8,982 1 $ 85,983 1 4% $ 56,015 1 $ 544,177 1 19% $ 11,609 1 $ (20,377) 64% ending through Carol Woods Retirement or deficit. DocuSign Envelope ID:51A7A137-A286-4E98-B5F2-A17F8C86549D cations that helped decrease expected ,ond our fundraising capacity to cover rand incorporating OCRA into CHCMOW- I Hill, Carrboro and Orange County. table organizations equivalent to $39,614. >27,488 but OCRA has not received any DocuSign Envelope ID:51A7Al37-A286-4E98-B5F2-Al7F8C86549D NCCHAP7 ACORD. CERTIFICATE OF LIABILITY INSURANCE F DATE YYY) 5/2020 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Nayab Alam The CIMA Companies, Inc. PHONE 703-778-7304 FAX 703-778-7354 A/C,No,Ext: (A/C,No): 2750 Killarney Dr, Suite 202 E-MAIL ss: nalam@cimaworld.com Woodbridge,VA 22192-4124 CUSTOMER ID#: 703 739-9300 INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A:Alliance of Nonprofits for Ins 10023 Chapel Hill-Carrboro Meals on Wheels INSURER B:Hartford Underwriters Insurance 30104 dba Meals on Wheels Orange County, NC INSURER C: `7 Carolina Casualty Insurance Com 10510 PO Box 2102 INSURER D: Chapel Hill, NC 27515 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDLSUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE NSR D POLICY NUMBER MM/DD MM/DD/YYYY LIMITS A GENERAL LIABILITY 202036882 07/01/2020 07/01/2021 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $500,000 CLAIMS-MADE F* OCCUR MED EXP(Any one person) $20,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICY PRO LOC $ A AUTOMOBILE LIABILITY 202036882 07/01/2020 07/01/2021 (E BINEDjSINGLE LIMIT $1 000000 ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE $ X HIRED AUTOS (Per accident) X NON-OWNED AUTOS $ $ UMBRELLA LAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ B WORKERS COMPENSATION 6S60UBOG11045218 07/01/2020 07/01/2021 X WCSTATU- OTH- AND EMPLOYERS'LIABILITY T RY LIMIT ER Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $100,000 OFFICER/MEMBER EXCLUDED? �N N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $500,000 A Liquor Liab 202036882 07/01/2020 07/01/2021 1,000,000 C D&O DCP1231894P8 07/03/2020 07/03/2021 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) The certificate holder is hereby listed as an additional insured. CERTIFICATE HOLDER CANCELLATION Orange County Government SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Attn: Risk Manager ACCORDANCE WITH THE POLICY PROVISIONS. P.O. Box 8181, Hillsborough, NC 27278 AUTHORIZED REPRESENTATIVE 01988-2009 ACORD CORPORATION.All rights reserved. ACORD 25(2009/09) 1 of 1 The ACORD name and logo are registered marks of ACORD #S391951/M389620 N PA DocuSign Envelope ID:5lA7A137-A286-4E98-B5F2-A17F8C86549D EXHIBIT `B" Scope of Services—FY 2020-21 Outside Agency Performance Agreement Agency Name: Select O Program Name: Meals on Wheels Orange County, NC Funding Award: $44,823 Outline how the agency will spend Orange County's funding award. Expense Description Amount Meal Subsidy $44,823 Program Services Outline the critical services(activities)the agency will employ to attain the Anticipated Outcomes below,by June 30,2021. Deliver balanced meals to eligible older adults across Chapel Hill, • Call recipients every other weekday to check-in Deliver additional food and supplies to recipients in greater need due to Anticipated Outcomes The Anticipated Results column must include quantifiable results in the form of number of persons/units served within Oran e County,only(all Towns and municipalities). If you use percentages,you must also provide the total number of participants within that measure's description or for an earlier performance measure. Performance Measures Anticipated Results 400 adults Increase number of seniors who have access to meal delivery and check- in up to 5 times per week. 200 adults Reduce Isolation/loneliness amongst older adults, homebound adults, (50%) disabled adults and those convalescing, measured via survey. 20 Community Outreach: Increase # of Volunteers to increase meal delivery additional service volunteers Certified by: 'Title: Executive Director Date: 11-19-2020 (Provider's Electronic Signature) "You will sign this document electronically with your performance agreement.